0
BY DR.ANIRUDH J SHETTY
PROF.DR.G.ELANGOVAN’S UNIT
28 yr male patient came with c/o
abdominal pain-1 week in duration
involving predominantly
the left upper and
centre of th...
 h/o early satiety +
 h/o loss of appetite +
 No h/o loss of weight
 No h/o jaundice
 No h/o haematemesis
 No h/o al...
 PAST h/o -> No h/o Tb/HTN/DM
 PERSONAL h/o -> consumes alcohol
occasionally
not a smoker
 O/E – Pt conscious
oriented
afebrile
anemic
no Cyanosis,clubbing,icterus,
lymphadenopathy
B.P-110/70 mmHG
P.R -80 min
 P/A –mild distention of abdomen+
no dialated viens,scars or sinuses
massive spleenomegaly(+) crossing
the umbilicus
no h...
 CVS – S1S2(+)
NO murmurs
RS – NVBS+
no added sounds
CNS - NFND
CBC
 Hb – 14
 TC – 9300
 P69,L31
 ESR – 15
 PLATLETS – 1,50,000
RFT
 RBS -152
 UREA – 32
 CREAT – 1.0
 SODIUM; 13...
 ECG – WNL
 CHEST X – RAY - WNL
CBC
TC – 1,60,000
SHIFT TO LEFT
BLAST 1%
HB – 9.2
PLATLET -1,80,000
Chronic phase of CML
 P/S
Markedly increased TC,
show...
 BONE MARROW FRAGMENT
SHOWING A DENSLLY CELLULAR MARROW
FRAGMENT WITH ABSENT FAT CELLS
 LOW POWER MICROSCOPE:
MYELOID HYPERPLASIA WITH RELATIVELY
REDUCED ERYTHROID PROGENITORS
 Patient was started on Imatinib mesylate
400mg 1-0-0
 CML accounts for 15% of all cases of
leukemia.
 More common in men
 Peak incidence : fourth and fifth decade
 In CML the c-ABL gene is translocated from
its normal abode on chromosone 9 to
chromosone 22,where it fuses with bcr gen...
1. CHRONIC PHASE
2. ACCELARATED PHASE
3. BLAST CRISIS
 EASY FATIGABILITY
 DECREASE TOLERANCE TO EXERTION
 ABDOMINAL DISCOMFORT AND EARLY
SATIETY( DUE TO SPLENIC ENLARGEMENT)...
 A physical examination may detect pallor and
splenomegaly.The latter was present in 90%
of patients.
UNCOMMON PRESENTATI...
 CML is often suspected on the basis on
the complete blood count, which shows
increased granulocytes of all types, typica...
 10–19% myeloblasts in the blood or bone
marrow.
 >20% basophils in the blood or bone marrow
 Platelet count <100,000, ...
 Blast crisis is the final phase in the evolution of CML, and
behaves like an acute leukemia, with rapid progression
and ...
 IMATINIB MESYLATE
 STEM CELL TRANSPLANTATION
 IFN-ALPHA
 HYDROXYUREA
 SECOND GENERATION TK INHIBITOR-
DASATINIB AND ...
 IMTINIB NOW IS USED AS INITIAL THERAPY IN
ALMOST ALL PATIENTS WITH CML.
 IN CASES WHERE WBC COUNT IS MARKEDLY
ELEVATED ...
 The bcr abl oncoprotien
with a molecule of ATP in
d kinase pocket.
 Phosphorylation - >
substrate .Activates
downstream...
HAEMATOLOGIC
RESPONSE
CYTOGENETIC
RESPONSE
MOLECULAR
RESPONSE(BCR
ABL TO
CONTROL GENE
RATIO
ACCORDING TO
IS SCALE)
FREQUEN...
SMENT METHOD
SUBOPTIMAL RESPONSE FAILURE
tologic No Complete hematologic
response(CHR) within 3
months
No hematologic resp...
 Second generation TKI like
DASATINIB
NILOTINIB
 Allogenic human stem cell transplant
 Well tolerated compared to other treatment
options in CML
 Superficial edema
 Nausea,muscle cramps
 Rash,Diarrhea
 U...
 Imatinib is not recommended during
pregnancy.
 Hydroxyurea has the lowest mutagenic
potential among the cytotoxic agent...
 Patients who are younger than 65 yrs and
who have a identical twin or a
histocompatible sibling can be transplanted
afte...
THANK YOU
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
A Case of Chronic Myeloid Leukemia
Upcoming SlideShare
Loading in...5
×

A Case of Chronic Myeloid Leukemia

2,947

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,947
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
57
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Transcript of "A Case of Chronic Myeloid Leukemia"

  1. 1. BY DR.ANIRUDH J SHETTY PROF.DR.G.ELANGOVAN’S UNIT
  2. 2. 28 yr male patient came with c/o abdominal pain-1 week in duration involving predominantly the left upper and centre of the abdomen vague dragging pain assoc with fullness of abd no h/o any aggravating or relieving factors
  3. 3.  h/o early satiety +  h/o loss of appetite +  No h/o loss of weight  No h/o jaundice  No h/o haematemesis  No h/o altered bowel habits  No h/o bleeding tendencies
  4. 4.  PAST h/o -> No h/o Tb/HTN/DM  PERSONAL h/o -> consumes alcohol occasionally not a smoker
  5. 5.  O/E – Pt conscious oriented afebrile anemic no Cyanosis,clubbing,icterus, lymphadenopathy B.P-110/70 mmHG P.R -80 min
  6. 6.  P/A –mild distention of abdomen+ no dialated viens,scars or sinuses massive spleenomegaly(+) crossing the umbilicus no hepatomegaly no FF+
  7. 7.  CVS – S1S2(+) NO murmurs RS – NVBS+ no added sounds CNS - NFND
  8. 8. CBC  Hb – 14  TC – 9300  P69,L31  ESR – 15  PLATLETS – 1,50,000 RFT  RBS -152  UREA – 32  CREAT – 1.0  SODIUM; 135  K+ - 6.0  CL – 105  HCO- 19
  9. 9.  ECG – WNL  CHEST X – RAY - WNL
  10. 10. CBC TC – 1,60,000 SHIFT TO LEFT BLAST 1% HB – 9.2 PLATLET -1,80,000 Chronic phase of CML  P/S Markedly increased TC, showsMYELOBLAST,PR OMYELOCYTE,METAMY ELOCYTE,BAND FORMS
  11. 11.  BONE MARROW FRAGMENT SHOWING A DENSLLY CELLULAR MARROW FRAGMENT WITH ABSENT FAT CELLS
  12. 12.  LOW POWER MICROSCOPE: MYELOID HYPERPLASIA WITH RELATIVELY REDUCED ERYTHROID PROGENITORS
  13. 13.  Patient was started on Imatinib mesylate 400mg 1-0-0
  14. 14.  CML accounts for 15% of all cases of leukemia.  More common in men  Peak incidence : fourth and fifth decade
  15. 15.  In CML the c-ABL gene is translocated from its normal abode on chromosone 9 to chromosone 22,where it fuses with bcr gene.  As a consequence of the fusion, c-ABL loses a region that controls tyrosine kinase activity. Thus the BCR-ABL protien,the product of the fusion gene has potent and constitutive tyrosine kinase activity.
  16. 16. 1. CHRONIC PHASE 2. ACCELARATED PHASE 3. BLAST CRISIS
  17. 17.  EASY FATIGABILITY  DECREASE TOLERANCE TO EXERTION  ABDOMINAL DISCOMFORT AND EARLY SATIETY( DUE TO SPLENIC ENLARGEMENT)  WIEGHT LOSS AND EXCESSIVE SWEATING The symptoms are vague, nonspecific and gradual in onset
  18. 18.  A physical examination may detect pallor and splenomegaly.The latter was present in 90% of patients. UNCOMMON PRESENTATIONS :  Dramatic hypermetabolism(night sweats,wt loss,heat intolerance)  Acute gouty arthritis(due to hyperurecemia)  Priapism,tinnitus  Lt upper quadrant n lt shoulder pain due to splenic infarction and perisplenitis.
  19. 19.  CML is often suspected on the basis on the complete blood count, which shows increased granulocytes of all types, typically including maturemyeloid cells.  Basophils and eosinophils are almost universally increased; this feature may help differentiate CML from a leukemoid reaction.  A bone marrow biopsy is often performed as part of the evaluation for CML, and CML is diagnosed by detecting the Philadelphia chromosome.
  20. 20.  10–19% myeloblasts in the blood or bone marrow.  >20% basophils in the blood or bone marrow  Platelet count <100,000, unrelated to therapy  Cytogenetic evolution with new abnormalities in addition to the Philadelphia chromosome  Increasing splenomegaly or white blood cell count, unresponsive to therapy
  21. 21.  Blast crisis is the final phase in the evolution of CML, and behaves like an acute leukemia, with rapid progression and short survival.  Blast crisis is diagnosed if any of the following are present in a patient with CML:  >20% myeloblasts or lymphoblasts in the blood or bone marrow.  Large clusters of blasts in the bone marrow on biopsy.  Development of a chloroma (solid focus of leukemia outside the bone marrow)
  22. 22.  IMATINIB MESYLATE  STEM CELL TRANSPLANTATION  IFN-ALPHA  HYDROXYUREA  SECOND GENERATION TK INHIBITOR- DASATINIB AND NILOTINIB
  23. 23.  IMTINIB NOW IS USED AS INITIAL THERAPY IN ALMOST ALL PATIENTS WITH CML.  IN CASES WHERE WBC COUNT IS MARKEDLY ELEVATED HYDROXYUREA CAN BE USED TO PREVENT HYPERLEUKOCYTIC SYNDROME.
  24. 24.  The bcr abl oncoprotien with a molecule of ATP in d kinase pocket.  Phosphorylation - > substrate .Activates downstream molecules  Imatinib occcupies d kinase pocket preventing phosphorylation of its substrates
  25. 25. HAEMATOLOGIC RESPONSE CYTOGENETIC RESPONSE MOLECULAR RESPONSE(BCR ABL TO CONTROL GENE RATIO ACCORDING TO IS SCALE) FREQUENCY .Every 2 weeks until a complete response has been achieved and confirmed. every 3 months unless othwise required every 6 months until a complete response has been achieved and confirmed. then every 12 months EVERY 3 MONTHS METHOD complete blood count (CBC) with differential Conventional cytogenetic examination .FISH (fluorescene in situ hybridisation) (only before treatment) .RQ-PCR (Reverse transcription quantitative polymerase chain reaction)
  26. 26. SMENT METHOD SUBOPTIMAL RESPONSE FAILURE tologic No Complete hematologic response(CHR) within 3 months No hematologic response within 3 months Loss of CHR at any time enetic No MCyR (Major cytogenetic response )within 6 months No CCyR(Complete cytogenetic response) within 18 months .No cytogenetic response within 6 months No MCyR within 12 mont No CCyR within 18 mont Loss of CCyR at any time Not applicable. CULAR No MMR(Major molecular response) within 8 months Loss of MMR at any time
  27. 27.  Second generation TKI like DASATINIB NILOTINIB  Allogenic human stem cell transplant
  28. 28.  Well tolerated compared to other treatment options in CML  Superficial edema  Nausea,muscle cramps  Rash,Diarrhea  Uncommon side effects:tumour lysis in accelerated phase,splenic rupture,cerebral edema,Varicella Zoster infections
  29. 29.  Imatinib is not recommended during pregnancy.  Hydroxyurea has the lowest mutagenic potential among the cytotoxic agents.  IFN can also be safely used during pregnancy.
  30. 30.  Patients who are younger than 65 yrs and who have a identical twin or a histocompatible sibling can be transplanted after intensive therapy usually with cyclophosphamide.  GVHD is common.
  31. 31. THANK YOU
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×